GI Medicine - Swallowing Problems Flashcards
what are the clinical signs of oropharyngeal disease?
drooling saliva (+/- blood)
halitosis
dysphagia
odynophagia
what is ptyalism?
overproduction of saliva
what may ptyalism be due to?
painful or diseased area of the mouth
what is pseudoptyalism?
normal amount of saliva produced but it is leaving the mouth rather than being swallowed
what are the non-oral causes of drooling/salivation?
nausea
mediaction
liver disease
what are the main causes of halitosis?
dental disease
oral and non-oral causes (e.g. lung infection or anal sac disease)
what is dysphagia?
difficulty eating or swallowing
what is odynophagia?
pain on swallowing
what is involved in the investigation of oral disease?
physical exam (sedation or GA may be needed) radiographs minimum database FNA and/or biopsy special tests
what must be considered about type and use of sedation/GA when patients have oral disease?
how feasible is intubation
what may you be looking for in the mouth of a patient with suspected oropharyngeal issues?
oropharyngeal foreign bodies
oral ulceration
oropharyngeal inflammatory disease
define chelitis
inflammation of the lips
define glossitis
inflammation of the tongue
define gingivitis
inflammation of the gums
define stomatitis
inflammation of the oral mucosa
define gingivostomatitis
inflammation of the gums and oral mucosa
what oropharyngeal neoplasia is seen in dogs?
benign and malignant
what oropharyngeal neoplasia is seen in cats?
almost all melignant
what is an example of a benign tumor?
epulis
what are examples of malignant oropharyngeal tumors?
squamous cell carcinoma
malignant melanoma
sarcomas
where may malignant tumors have effect?
locally invasive
metastatic (LN and lungs)
how is oropharyngeal disease treated?
depends on underlying cause
how is oropharyngeal neoplasia treated?
surgery
cryosurgery, radiation, chemotherapy
how is oropharyngeal foreign body treated?
remove
how is oropharyngeal trauma treated?
wound management
surgery
how is oropharyngeal inflammation treated?
anti-inflammatories
how is oropharyngeal bacterial infection treated?
antibiotics
what are the main nursing considerations for oral disease?
analgesia
nutritional considerations (oral with soft food or bypass/tube feeding)
barrier nursing if needed
what analgesia may be given to oral patients?
opioids
NSAIDs - if eating
what has an important role in any oral disease?
oral hygiene
what can poor oral / dental hygiene lead to?
causative of infections
source of ongoing bacteria/oropharyngeal inflammation or infection
how can oral hygiene be maintained?
oral rinses
tooth brushing
cat and dog specific enzymatic tooth paste
+/- dental extractions
what is key about the oral hygiene of anorexic or ventilated patients?
mm will be dry to reduced production of saliva (either through not eating or unconsciousness) - saliva has protective antimicrobial functions so infection is a risk
define dysphagia
difficulty swallowing
define odynophagia
swallowing pain
define regurgitation
passive return of food/water or saliva
where is the problem located if dysphagia is seen?
oropharyngeal (occasionally oesophageal)
where is the problem located if odynophagia is seen?
oropharyngeal and oesophageal
where is the problem located if regurgitation is seen?
oesophageal
what is regurgitation a hallmark of?
oesophageal disease
define vomiting
active forceful, reflex ejection of gastric and upper intestinal content following stimulation of a neural reflex that has synaptic centres in the brainstem
is vomiting a sign or a diagnosis?
sign
what may vomiting be due to?
GI or extra-GI disease
what will change depending on whether regurgitation or vomiting is present?
investigations
when may regurgitation occur?
immediate or delayed
what will products of regurgitation look like?
undigested food
+/- mucous or saliva covering
what is the pH of regurgitated material?
neutral as no stomach acid
when my fresh blood be seen in regurgitated material?
if ulceration present
is regurgitated material solid or liquid?
either
is it possible to tell the difference between vomit and regurgitated material just by looking at it?
no - need to see the process happening to know
what are the secondary problems and complications associated with regurgitation?
malnutrition dehydration anorexia or perceived polyphagia reflux pharyngitis or rhinitis aspiration pneumonia swallowing pain
what is polyphagia?
excessive appetite
what is reflux pharyngitis / rhinitis caused by?
regurgitation up into nose
what is the sign of reflux pharyngitis / rhinitis?
nasal discharge
what are the main signs of aspiration pneumonia?
cough
dyspnoea
pyrexia
how is oesophageal disease investigated?
physical exam
chest x rays (+/- fluoroscopy)
laboratory tests (haem and biochem)
oesophagoscopy
under what level of sedation must chest x rays be performed?
conscious so that oesophagus does not collapse and reflux risk is reduced
what are the main pathophysiologies associated with oesophageal disease?
megaoesophagus
oesophagitis
oesophageal obstruction
what are the types of oesophageal obstruction?
complete or partial
intraluminal or intramural
extraluminal
what is intraluminal oesophageal obstruction?
something in the lumen of the oesophagus
what is intramural oesophageal obstruction?
growth from oesophageal wall which reduces patancy
what is extraluminal oesophageal obstruction?
something outside of the oesophagus which is compressing it
what is mega oesophagus?
oesophageal dilation / dysfunction due to weakened muscles
what are the two types of megaoesophagus?
generalised (whole oesophagus)
focal dilation
what are the causes of megaoesophagus?
idiopathic myasthenia gravis (localised or systemic signs)
what is vascular ring anomaly?
ligament tethers oesophagus and makes it difficult for food to pass the heart apex leading it to build up
how is megaoesophagus treated?
idiopathic - no cure, supportive therapy
myasthenia gravis - drugs to aid transmission of nerve impulses
vascular ring anomaly - surgery to cut ligament tethering oesophagus
nursing care to manage impact of oesophageal dysfunction
what is involved in the nursing management of megaoesophagus?
postural feeding to use gravity to help function
textured food is less likely to be regurgitated
how can postural feeding for megaoesophagus be managed?
stairs or worktop
bailey chair is specifically designed to support
what are the main complications of megaoesophagus?
aspiration pneumonia
loss of bodyweight and condition
how is aspiration pneumonia treated?
IV antibiotics and O2 therapy
what type of studies should be avoided in patients with oropharyngeal issues?
barium - may be aspirated and cause serious lung damage
what is oesophagitis?
oesophageal inflammation
what is oesophagitis caused by?
ingestion of caustics, hot liquids or foods, foreign bodies, irritants (e.g. doxycycline)
gastro oesophageal reflux
persistent vomiting
what may oesophagitis lead to?
oesophageal strictures
what are the causes of gastro-oesophageal reflux?
anaesthesia
persistent vomiting
hiatal hernia
GERD - heart burn (spontaneous)
what factors may predispose GERD - spontaneous reflux?
obesity
BOAS
what happens during gastro-oesophageal reflux?
reflux of gastric acids and enzymes leading to inflammation
what are the signs of oesophagitis?
regurgitation hypersalivatin anorexia pain weight loss
how is oesophagitis managed?
oesophageal rest (starve or gastrotomy feeding)
analgesia (topical or systemic)
liquid antacid gels or coating agents
acid blockers (omeprazole)
drugs to reduce further reflux by closing sphincter
what diet should oesophagitis patients be fed?
low fat - fat slow gastric emptying
where can oesophageal foreign bodies be lodged?
anywhere in the oesophagus
what are the signs of oesophageal foreign body?
obstruction
regurgitation
may be able to drink
what diets pose a risk of oesophageal foreign body?
raw or bone feeding
how are oesophageal foreign bodies removed?
endoscopically
fluroscopically
may need surgery (perf?)
what is the cause of oesophageal stricture?
fibrosis after severe ulceration of mucosa
how can oesophageal stricture be treated?
re-stretch oesophagus using balloon
why is surgery not an option to treat oesophageal stricture?
surgery likely to cause further stricture
